Study: No Infection Prevention Benefits of Antibiotic Cement for TKA

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A study has shown that routine use of antibiotic-loaded bone cement in primary total knee arthroplasty (TKA) has no measurable impact on periprosthetic joint infection rates.

Published in The Journal of Arthroplasty, the study involved review of a consecutive series of patients undergoing cemented primary TKA at two hospitals from 2015 to 2017. More than 2,500 patients were analyzed.

Of the 2,500 patients, about 1,100 received antibiotic-loaded bone cement during their procedure. Researchers found there was no difference in periprosthetic joint infection rates between patients receiving and not receiving antibiotic cement. Furthermore, patients receiving the antibiotic cement had overall high procedure costs — by about $300.

As Healio reports, one of the study's authors — Dr. Michael Yayac — recently presented on the findings at the 29th annual Musculoskeletal Infection Society Annual Open Scientific Meeting. During the presentation, Healio quotes Dr. Yayac as saying, "Routine use of antibiotic cement is not cost effective in preventing infection in primary TKA and should be avoided with value-based alterative payment models that incentivize to reduce unnecessary costs. However, given that this was performed in a relatively healthy population at orthopedic specialty hospitals, further studies would be needed to determine [whether] certain high-risk patients would benefit from its use and would be considered a cost-effective measure."

NY Times Puts Spotlight on Duodenoscope Sterilization Challenges

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A recent article in The New York Times examines the difficulty healthcare providers face in properly sterilizing duodenoscopes.

The article — "Why Are These Medical Instruments So Tough to Sterilize?" — begins by noting the tremendous value of using duodenoscopes. It then describes the unusual and sometimes unsatisfactory cleaning process these devices must undergo. When this process comes up short, causing a duodenoscope to retain bacteria, patient safety is jeopardized. Numerous patients have become ill from contracting infections — including antibiotic-resistant infections — from dirty duodenoscopes.

As a result, the article notes, some medical experts have reached out to the U.S. Food and Drug Administration (FDA), pressing the agency to either require manufacturers to develop duodenoscopes that can be properly sterilized or take them off the market. Supporting this request is data that recently showed one in 20 duodenoscopes retained bacteria after undergoing proper cleaning processes.

In the piece, UNC Health Care's Dr. David Jay Weber, medical director for UNC, is quoted as saying, "Would you go on an airplane if the pilot said, 'By the way, there is a 5% chance the engines will fail'? Would you go in a car if the manufacturer said, 'There are airbags, but 5% of the time they won't deploy'?"

Infection Control Consulting Services (ICCS) regularly draws attention to duodenoscope infection prevention challenges. While duodenoscopes are designed differently from colonoscopes and gastroscopes, performing appropriate high-level disinfection that comply with manufacturers' instructions for use (IFUs) and nationally recognized guidelines remains critical for these scopes as well. Any shortcomings in following IFUs and guidelines can significantly increase infection risks. If your organization requires assistance with central sterile processing, learn how ICCS can help.